NAIROBI, Kenya – Persistent fatigue, brain fog and weakness are often blamed on stress, poor sleep or a busy schedule. But sometimes, the problem may be a lack of iron — a common nutritional deficiency that can go unnoticed for months or even years.
Iron helps the body produce haemoglobin, the protein in red blood cells responsible for carrying oxygen to tissues and organs. When iron stores fall, the body may struggle to perform everyday functions efficiently.
Importantly, iron deficiency can occur even when a person is not anaemic. This means a routine blood count may not always detect the problem unless iron stores are also assessed. Updated clinical guidance issued in September 2026 highlights the importance of recognising and diagnosing iron deficiency before it progresses to anaemia.
1. Persistent tiredness and low energy
Feeling exhausted despite getting enough sleep can be one of the most common signs of iron deficiency.
When the body lacks sufficient iron, its ability to produce haemoglobin may be affected, reducing the amount of oxygen delivered to tissues. Everyday activities such as walking, climbing stairs or completing routine tasks may begin to feel unusually demanding.
However, fatigue has many possible causes, including sleep disorders, infections, thyroid problems and other nutritional deficiencies. Tiredness alone cannot confirm low iron levels.
2. Brain fog and difficulty concentrating
Iron plays a role in normal brain function. Some people with iron deficiency report difficulty concentrating, reduced mental clarity or a feeling that their thinking has slowed down.
These symptoms can be subtle and may be mistaken for stress, overwork or inadequate sleep. They can also occur with numerous other conditions, so a medical assessment is important if they persist.
3. Shortness of breath, dizziness or a racing heartbeat
When iron deficiency progresses to anaemia, the blood may carry less oxygen than the body needs.
This can lead to breathlessness during physical activity, dizziness, headaches or a noticeable increase in heartbeat. Some people may also experience cold hands and feet or look paler than usual.
Seek urgent medical attention if you experience severe shortness of breath, chest pain, fainting or a persistent racing heartbeat, particularly if these symptoms are new or worsening.
4. Hair loss, brittle nails and changes in skin colour
Iron deficiency may be associated with hair loss and changes in nail strength or shape. In some cases, nails become brittle or develop a spoon-like appearance.
Pale skin can also occur when anaemia develops, although complexion varies naturally and can be affected by many other factors.
Social media has popularised the term “ferritin face” to describe under-eye darkness, paleness and other facial changes supposedly linked to low iron stores. However, a selfie cannot reliably diagnose iron deficiency. Dark circles and skin changes have many potential explanations, and blood testing is needed to assess iron status.
5. An unusual urge to chew ice or eat non-food items
An unusual craving for non-food substances, a condition known as pica, can sometimes accompany iron deficiency.
Some affected people develop a strong urge to chew ice, while others may crave substances such as clay or paper. The reason for these cravings is not fully understood.
Persistent ice chewing or cravings for non-food items are worth discussing with a healthcare professional, particularly when accompanied by fatigue or other symptoms.
6. Restless legs, especially at night
Iron deficiency has been associated with restless legs syndrome, which can cause uncomfortable sensations in the legs and an overwhelming urge to move them, particularly while resting or trying to sleep.
The resulting sleep disruption may compound daytime fatigue, creating a cycle in which a person feels exhausted despite spending enough time in bed.
Restless legs can have other causes, however, and do not automatically indicate an iron deficiency.
7. Reduced exercise performance
People who previously exercised comfortably may notice that they become tired more quickly, struggle to maintain their usual pace or take longer to recover after physical activity.
Endurance athletes can be particularly vulnerable because of increased iron requirements and other factors associated with intensive training.
A decline in performance is not proof of low iron, but persistent changes may warrant an assessment, especially when accompanied by breathlessness, dizziness or unusual fatigue.
Who is most at risk of iron deficiency?
Some groups have a greater risk of developing low iron stores because they lose more blood, require additional iron or have difficulty absorbing it.
These include:
- People with heavy menstrual periods: Regular blood loss can gradually deplete iron stores.
- Pregnant women: Iron requirements rise during pregnancy to support maternal health and the developing baby.
- Children and adolescents: Growth and development increase the body’s demand for iron.
- People with restricted diets: Those who consume few iron-rich foods may struggle to meet their needs.
- People with digestive conditions: Conditions such as coeliac disease and inflammatory bowel disease can interfere with iron absorption.
- People experiencing ongoing blood loss: Gastrointestinal bleeding, among other causes, can lead to iron deficiency.
- Endurance athletes: Increased physiological demands can raise the risk of depleted iron stores.
Iron deficiency should not automatically be blamed on diet. In some cases, it may be a sign of heavy menstrual bleeding, impaired absorption or hidden blood loss that requires investigation.
How do you know if you are iron deficient?
A blood test is the most reliable way to establish whether iron stores are low. A healthcare professional may recommend a full blood count alongside a serum ferritin test, which measures the body’s stored iron.
A full blood count helps identify anaemia, while ferritin can reveal depleted iron stores even before anaemia develops. In certain circumstances, additional tests — such as transferrin saturation, which assesses how much iron is available for transport — may be needed.
Clinical guidance released by the American Society of Hematology in September 2026 recommends different ferritin thresholds for different groups. Its guidance includes:
- Children aged nine months to four years: ferritin of 20 ng/mL or lower.
- Most adults, including menstruating and pregnant individuals: 30 ng/mL or lower.
- Certain higher-risk groups: a threshold of 50 ng/mL or lower.
- Adults with inflammation: ferritin below 100 ng/mL or transferrin saturation below 20pc may indicate iron deficiency, depending on the clinical context.
These are clinical decision thresholds, not a substitute for professional interpretation. Inflammation and some illnesses can raise ferritin levels, potentially masking an underlying deficiency. Results must therefore be considered alongside symptoms, medical history and other tests.
Can you treat iron deficiency with food or supplements?
Iron-rich foods can help maintain adequate iron intake. Options include meat, fish, beans, lentils, peas, dark-green leafy vegetables and iron-fortified cereals.
Vitamin C-rich foods, such as citrus fruits, tomatoes and peppers, can help the body absorb iron from plant-based foods.
However, diet alone may not correct an established deficiency, particularly when blood loss or an absorption problem is involved. A healthcare professional may recommend iron supplements and investigate the underlying cause.
Avoid taking high-dose iron supplements simply because you feel tired. Excess iron can be harmful, and the appropriate treatment depends on whether a deficiency is present, how severe it is and what caused it.
When should you seek medical advice?
Consider arranging a medical assessment if you experience persistent unexplained fatigue, recurring dizziness, unusual breathlessness during activity, hair loss alongside other symptoms, heavy menstrual bleeding or cravings for non-food items.
Seek prompt medical attention if you suspect blood loss, notice blood in your stool or have unexplained worsening symptoms. Severe breathlessness, chest pain or fainting require urgent care.
The key takeaway is simple: you do not have to be anaemic to have low iron, and you cannot confirm iron deficiency from appearance alone. If persistent tiredness is affecting your daily life, a proper assessment and appropriate blood tests can help identify the cause and guide treatment.
